12-sq-110bb transcription servicesgov.findrfp.com/docs/17677_solicitation-final.pdf ·...

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FINANCIAL AND ADMINISTRATIVE SERVICES

Purchasing and Contracts 123 West Indiana Avenue • Room 302• DeLand, FL 32720-4608

Phone: 386-736-5935 • Fax: 386-736-5972

E-mail: [email protected] Web: www.volusia.org

Submittal Due Date

Tuesday, October 2, 2012

Submittal Due Time

3:00 p.m.

Submit Responses To: County of Volusia Purchasing and Contracts Division 123 West Indiana Avenue, Room 302 DeLand, FL 32720-4608

Project Contact Becki Bishop, Procurement Analyst Phone: 386-822-5764 • Fax: 386-736-5972 E-mail: [email protected] www.volusia.org/bidlist

12-SQ-110BB

TRANSCRIPTION SERVICES

The purpose of the Request for Statement of Qualifications (RSQ) is to select the most highly

qualified firm(s) to provide the requested services. Submittals will be reviewed and evaluated as to

qualifications to perform the services required by an Evaluation Committee consisting of one

member of the County Council and County staff, who will make a recommendation for award by the

County Council.

It is anticipated that one firm shall be selected to provide the necessary services for a contract period

of three (3) years with two (2) one-year renewals permissible upon mutual written agreement and

county council approval, when applicable.

DO NOT RESPOND TO THIS SOLICITATION ON LINE

Expressions of interest and qualification data will be received at the office of the Volusia County

Purchasing & Contracts Division, 123 W. Indiana Avenue, 3rd Floor, Room 302, DeLand, FL

32720-4608, until 3:00 p.m. on Tuesday, October 2, 2012. Submittals received after this deadline

will not be considered for award. The purpose of the Request for Statement of Qualifications (RSQ)

is to select the most highly qualified firm(s) to provide Transcription Services.

mailto:[email protected]

http://www.volusia.org/


http://www.volusia.org/bidlist


SCOPE OF SERVICE: A general description of the scope of professional services required is, but

not limited to, the following:

Volusia County Government intends to issue this Request for Statement of Qualifications (RSQ) for

a transcription services contract(s) to further assist the hearing disabled as it pertains to participation

in County Council meetings. The County is seeking a Contractor to furnish administrative,

logistical, professional, and technical labor, supplies, equipment, and materials necessary to provide,

transcription services of County Council meetings accessible through Fire Fox, Google Chrome and

Internet Explorer, as well as electronic and hard-copy transcripts. The length of each County Council

meeting ranges from six (6) hours to more than ten (10) hours. Meetings are held twice a month on

Thursdays at 9:00 a.m. EST Special meetings are also held throughout the year.

Volusia County currently provides live streaming audio of County council meetings on its website,

volusia.org. Council audio is captured and compressed using the AAC audio codec as 16-bit audio,

with a 48 kHz sampling rate. This audio stream is then placed inside a Flash Video (F4V) wrapper

and is pushed to a Wowza media server housed at Solodev (the County's web hosting provider). The

Wowza media server then rebroadcasts the feed as streaming audio using the MP4 media format.

Minutes are posted on the website at a later date. The County has six (6) assistive listening devices in

the County Council chambers that are available upon request; the devices do not work outside of

County Council chambers.

The County is seeking service to provide real-time text transcription services for regular and special

meetings of the County Council as needed. The County will provide audio stream to be transcribed

on the County’s website, volusia.org and on LCD/TV monitors in the County Council chambers.

Volusia County staff may be responsible for purchase and set-up of technical equipment.

QUALIFICATIONS

The preferred firm will have significant and demonstrated experience in working with projects of

similar size and scope. The preferred firm will also demonstrate the following:

Provide live action or recording of the audio transcription process from start to finish of a specific

project.

DEFINITIONS

As used in this RSQ, the following terms shall have the meanings set forth below:

Consultant: That person or entity, including employees, partners, principals, agents and assignees of

the person or entity that has submitted a bid or proposal for the purpose of obtaining business with

the County to provide the product and/or services set forth herein. This term is interchangeable with

the term Respondent and Contractor.

Contract: The document resulting from this solicitation between the County and the Respondent,

including this RSQ, along with any written addenda, the Respondent’s complete proposal submitted

in response to this RSQ and other written documents, which are expressly incorporated by reference.

Contractor: That person or entity, including employees, partners, principals, agents and assignees of


the person or entity that has submitted a bid or proposal for the purpose of obtaining business with

the County to provide the product and/or services set forth herein. This term is interchangeable with

the term Respondent and Consultant.

Contract Administrator: The County’s Director of Purchasing and Contracts or designee shall

serve as Contract Administrator. The Contract Administrator shall be responsible for addressing any

questions about or concerns within the scope of the Contract. Any changes to the resulting Contract

shall be done in writing and authorized by the County’s Director of Purchasing and Contracts.

County: The word County refers to the County of Volusia, Florida.

County’s Project Manager(s): The Project Manager(s) have responsibility for the day to day

administration of the resulting Contract for the County and will be designated prior to award of

Contract.

Day: The word “day” means each calendar day or accumulation of calendar days.

Director: The Director is the Director of Purchasing and Contracts for the County of Volusia.

Person or Persons: An individual, firm, partnership, corporation, association, executor,

administrator, trustee or other legal entity, whether singular or plural, masculine or feminine, as the

context may require.

Respondent: That person or entity, including employees, partners, principals, agents and assignees

of the person or entity that submits a proposal for the purpose of obtaining a Contract with the

County for the provision of the services set forth herein. This term is interchangeable with the term

Contractor and Consultant.

Respondent’s Project Manager: The Project Manager has responsibility for administering this

Contract for the Respondent and will be designated prior to execution of the Contract.

Sub-Contractor: An agency who is contractually bound to provide services described in this RSQ

on behalf of the Respondent.

DELIVERABLES

It shall be the responsibility of the awarded firm to provide to the County in relation to the scope of

work the following deliverables:

A. Live transcription services of County Council meetings;

B. Electronic copy of transcripts of County Council meetings;

C. Hard copy of transcripts of County Council meetings.

EVALUATION CRITERIA Each proposal shall be evaluated using the following criteria:

A. Proper submittal of ALL documentation as required by this proposal.


B. The greatest benefits to Volusia County as it pertains to:

1. Adequacy and completeness of proposal;

2. Qualifications of the firm and the employees assigned to the County (submit in Tabs 1

and 5);

3. Experience in providing similar services (submit in Tab 2);

4. Quality of performance on previous contracts or services;

5. Overall project methodology/approach to support the needs and objectives of the project,

including an implementation plan (submit in Tab 3);

6. Cost (submit in Tab 4);

7. Resources and qualifications of the Contractor’s personnel; (submit in Tab 5);

8. Financial stability of the firm (submit in Tab 11).

PROPOSED SCHEDULE

08/27/12 ...........................Release date for Request for Statement of Qualifications (RSQ)

09/13/12 ...........................Pre-proposal Conference

09/18/12 ...........................Final date to receive written questions

10/02/12 ...........................Closing Date

TBD ..................................Evaluation Committee

TBD ..................................Presentations, if required

TBD ..................................Recommendation to Council

January, 2013 ...................Project Start Date

PRE-PROPOSAL CONFERENCE

A. A pre-proposal conference will be held in the Purchasing Conference Room, 123 W. Indiana

Avenue, Room 300, DeLand, FL, at 9:00 a.m., local time, on Thursday, September 13, 2012.

While this is not mandatory, all interested parties are encouraged to attend and participate.

B. In accordance with the Americans with Disabilities Act and Section 286.26, Florida Statutes,

persons with disabilities and who need special accommodations to participate in the

proceedings should contact the Volusia County Purchasing and Contracts Office in DeLand

with a written request at least two (2) business days prior to the meeting date. Facsimiles are

acceptable and may be sent to 386-736-5972.

PUBLIC PROPOSAL OPENING

A. Pursuant to Section 119.071, Florida Statutes, proposals (“responses”) and the completed

tabulation will be available for inspection within thirty (30) days of response opening.

Contact the Purchasing and Contracts Office during regular business hours to inspect

responses and the completed tabulation or, for inspection of the completed tabulation, go to

http://vcservices.vcgov.org/bidlistnet1/. The foregoing notwithstanding, if, prior to the

County’s making responses available for inspection, the County rejects all responses and

concurrently provides notice of the County’s intent to reissue the solicitation, then the

County may avail itself of the exemption for rejected responses set forth in Section 119.071,

Florida Statutes, to the extent such section may apply.

http://vcservices.vcgov.org/bidlistnet1/


B. In accordance with the Americans with Disabilities Act and Section 286.26, Florida Statutes,

persons with disabilities and who need special accommodations to participate in the

proceedings should contact the Volusia County Purchasing and Contracts Office in DeLand



AWARD

The County reserves the right to award the contract to the respondent(s) that the County deems to

offer the most responsive and responsible proposal(s), as defined elsewhere in this solicitation. The

County is therefore not bound to accept a proposal based only on lowest price. In addition, the

County has the sole discretion and reserves the right to cancel this RSQ, to reject any/all proposals,

to waive any/all informalities and/or irregularities, or to re-advertise with either the identical or

revised specifications, if it is deemed to be in the best interest of the County to do so. Nothing

prohibits the County from rejected/rebidding when responses exceed budget and the County must

change the solicitation to lower costs. The County also reserves the right to make multiple awards

based on experience and qualifications or to award only a portion of the items and/or services

specified, if deemed to be in the County’s best interest.

PAYMENT TERMS

A. The County will remit full payment on all undisputed invoices within forty-five (45) days

from receipt by the appropriate person(s) (to be designated at time of Contract) of the

invoice(s) or receipt of all products or services ordered.

B. Pursuant to Chapter 218, Florida Statutes, the County will pay interest not to exceed one

percent (1%) per month on all undisputed invoices not paid within thirty (30) days after the

due date.

C. The County has the capabilities of Electronic Fund Transfer (EFT). List any discounts for

prompt payment and/or willingness to accept Electronic Funds Transfer (EFT) and the

discount to be applied to such payments.

D. By submitting a proposal to the County of Volusia, Florida, the Respondents expressly agree

that, if awarded a contract, the County may withhold from any payment monies owed by the

Respondent to the County for any legal obligation between the Respondent and the County,

including but not limited to real property taxes, personal property taxes, fees, and

commissions.

CONTRACT

A. The contents of this RSQ and all provisions of the successful proposal deemed pertinent by

the County shall be, at the sole discretion of the County, incorporated into a separate contract

and become legally binding on the selected proposer. Content of the contract may contain

changes as a result of the RSQ process and submittal received. The contract shall include, at

minimum, the terms and conditions as outlined in RSQ and subject to review by the County

attorney or designee for determination of legal form and substantive sufficiency prior to

approval and execution and contain additional terms and conditions that the County deems in


its best interest.

B. The Director of Purchasing and Contracts, County Manager and County Chair are the sole

contracting officers of contract and they or their designees are authorized to make contract

changes.

C. County of Volusia shall not be responsible for any order, change substitution or any other

discrepancy from the contract, without an amendment to the contract.

INSURANCE REQUIREMENTS

A. Required Types of Insurance

The Contractor shall purchase and maintain at its own expense, during the term of this

Contract the following types and amounts of insurance with limits no less than those shown

below, in the form and from companies satisfactory to the County:

SCHEDULE LIMITS

Workers’ Compensation Florida Statutory Coverage

Employers Liability ............................................ $100,000. Each Accident

(including Appropriate Federal Acts) ................ $500,000. Disease Policy Limit

................................................................ $100,000. Each Employee/Disease

Commercial General Liability ......................... $2,000,000. General Aggregate

………............................................................. $2,000,000. Products/CompOps Aggregate

Products-Completed Operation ....................... $1,000,000. Personal/Advertising Injury

…………......................................................... $1,000,000. Each Occurrence

(The County of Volusia shall be named as an additional insured under all of the above

Commercial General Liability coverage.)

Auto Liability ..................................................... $500,000. CSL

All autos-owned, hired, or non-owned

(Symbol 1 Coverage)

Professional Liability ...................................... $1,000,000.

(Errors & Omissions)

1. Minimum underlying coverage shall include Commercial General Liability,

Automobile Liability and Workers’ Compensation/Employer’s Liability. (Umbrella

liability limit will not be required to be carried by subcontractors.)

2. Umbrella or Excess Liability policies may be used to obtain the total limits of

liability required to meet the required limits of coverage stated above. Evidence of

such coverage should clearly demonstrate the underlying coverage/policies that are

included.

3. Workers’ Compensation Insurance. Per Section A, Insurance Requirements,

Workers’ Compensation insurance is required for all employees of the Contractor,


employed or hired to perform or provide Work or Services under this Contract or that

is in any way connected with Work or Services performed under this Contract,

without exclusion for any class of employee, and shall comply fully with the Florida

Workers’ Compensation Law (Chapter 440, Florida Statutes, Workers’

Compensation Insurance) and include Employers’ Liability Insurance with limits no

less than the statutory amount shown above per occurrence.

a. Contractor and its Subcontractors, or any associated or subsidiary company doing

Work on County property or under this Contract must be named in the Workers’

Compensation coverage or provide proof of their own Workers’ Compensation

coverage, without exclusion of any class of employee, and with a minimum of the

statutory limits per occurrence for Employer’s liability coverage. Further, if the

Contractor's Subcontractors fail to obtain Workers’ Compensation insurance and

a claim is made against the County by the uncovered employee of said

Subcontractor of the Contractor, the Contractor shall indemnify, defend, and hold

harmless the County from all claims for all costs including attorney’s fees and

costs arising under said employee(s) Workers’ Compensation insurance claim(s).

4. Commercial General Liability Insurance. Per Section A, Insurance Requirements,

Commercial General Liability insurance, with a limit of not less than the amounts

shown above with an aggregate limit and per occurrence basis, including coverage for

the Contractor’s operations, independent Contractors, Subcontractors and “broad

form” property damage coverage protecting itself, its employees, agents, Contractors

or subsidiaries, and their employees or agents for claims for damages caused by

bodily injury, property damage, or personal or advertising injury, products

liability/completed operations including what is commonly known as groups A, B,

and C (libel, false arrest, slander). Such policies shall include coverage for claims by

any person as a result of actions directly or indirectly related to the employment of

such person or entity by the Contractor or by any of its Subcontractors arising from

Work or Services performed under this Contract. Public liability coverage shall

include either blanket contractual insurance or a designated contract contractual

liability coverage endorsement, indicating expressly the Contractor’s contract to

indemnify, defend, and hold harmless the County as provided in this Contract. The

commercial general liability policy shall be endorsed to include the County as an

additional insured. The commercial general liability policy shall provide exclusive

coverage for the location or project site where the Work or Services are to be

performed under this Contract. In the alternative, the commercial general liability

policy shall be endorsed to provide the designated aggregate per location

endorsement or equivalent on a form approved or requested by the County Risk

Manager.

5. Motor Vehicle Liability. Per Section A, Insurance Requirements, the Contractor

shall secure and maintain during the term of this Contract, motor vehicle coverage in

the split limit amounts of no less than the amounts shown above per person, per

occurrence, for bodily injury and for property damage or a combined single limit of

the amount shown above (including “Any Auto” Symbol 1 coverage), protecting

itself, its employees, agents or lessees, or subsidiaries and their employees or agents

against claims arising from the ownership, maintenance, or use of a motor vehicle.


6. Professional Liability. Per Section A, Insurance Requirements, the Contractor shall

ensure that it secures and maintains, during the term of this Contract, Professional

Liability insurance with limits of no less than the amount shown above contemplated

by this Contract. Such policy shall cover all the Contractor’s or its Subcontractor’s

professional liabilities whether occasioned by the Contractor or its Subcontractors, or

their agents or employees.

a. If the Contractor fails to secure and maintain the professional liability insurance

coverage required herein, the Contractor shall be liable to the County and agrees

to indemnify, defend, and hold harmless the County against all claims, actions,

losses, or damages that would have been covered by such insurance.

b. The Contractor must maintain a retroactive date prior to or equal to the effective

date of this Contract. The Contractor shall purchase a Supplemental Extended

Reporting Period (“SERP”) with a minimum reporting period of not less than

three (3) years in the event a Subcontractor’s policy is canceled, not renewed,

switched to occurrence form, or any other event which requires a purchase of

SERP to cover a gap in insurance for claims which may arise under or related to

this Contract. The Contractor’s purchase of the SERP shall not relieve the

Contractor of the obligation to provide replacement coverage. In addition, the

Contractor shall require that the Subcontractor’s carrier immediately inform the

Contractor, the County of Volusia’s Risk Management Division, and the

Purchasing and Contracts Division of any contractual obligations that may alter

its professional liability coverage under this Contract.

7. Coverage for professional liability shall be provided on an Occurrence form or a

Claims Made form with a retroactive date equal to at least the first date of this

Contract and with a three year reporting option beyond the expiration date of the

Contract including any amendments to the Contract term.

8. Primary and Excess Coverage. Any insurance required may be provided by primary

and excess insurance policies.

B. Insurance Requirements

1. General Insurance Requirements:

a. All insurance policies shall be issued by insurers licensed and/or duly authorized

under Florida Law to do business in the State of Florida and all insuring

companies are required to have a minimum rating of A- in the "Best Key Rating

Guide" published by A.M. Best & Company, Inc.

b. Approval by County of any policy of insurance shall not relieve Contractor from

its responsibility to maintain the insurance coverage required herein for the

performance of Work or Services by the Contractor or its Subcontractors for the

entire term of this Contract and for such longer periods of time as may be

required under other clauses of this Contract.


c. Waiver of Subrogation. The Contractor hereby waives all rights against the

County and its Subcontractors to the extent of the risk coverage by any insurance

policy required hereunder for damages by reason of any claim, demand, suit or

settlement (including workers’ compensation) for any claim for injuries or illness

of anyone, or perils arising out of this Contract. The Contractor shall require

similar waivers from all its Subcontractors. This provision applies to all policies

of insurance required under this Contract (including Workers’ Compensation, and

general liability).

d. County Not Liable for Paying Deductibles. For all insurance required by

Contractor, the County shall not be responsible or liable for paying deductibles

for any claim arising out of or related to the Contractor’s business or any

Subcontractor performing Work or Services on behalf of the Contractor or for the

Contractor’s benefit under this Contract.

e. Cancellation Notices. During the term of this Contract, Contractor shall be

responsible for promptly advising and providing the County’s Risk Management

and the Purchasing and Contracts divisions with copies of notices of cancellation

or any other changes in the terms and conditions of the original insurance policies

approved by the County under this Contract within two (2) business days of

receipt of such notice or change.

f. For any on-site Work performed by or on behalf of Contractor on County

property, the County shall be named as an additional insured or additional named

insured subject to review and determination by County’s Risk Manager on all

policies required under this Contract, except professional liability.

g. Deductibles. For purposes of this Contract, Contractor shall not obtain an

insurance policy with a deductible or self-insurance provision.

C. Proof of Insurance

1. The Contractor shall be required to furnish evidence of all required insurance in the

form of certificates of insurance which shall clearly outline all hazards covered as

itemized herein, the amounts of insurance applicable to each hazard, and the

expiration dates.

2. The Contractor shall furnish proof of insurance acceptable to the County prior to or at

the time of execution of this Contract and the Contractor shall not commence Work

or provide any Service until the Contractor has obtained all the insurance required

under this Contract and such insurance has been filed with and approved by the

County. Upon request from the County, the Contractor shall furnish copies of the

following types of insurance policies and any changes or amendments thereto,

immediately, to the County and County’s Risk Management and Purchasing and

Contracts Divisions, prior to the commencement of any contractual obligations. This

Contract may be terminated by the County, without penalty or expense to County, if


at any time during the term of this Contract proof of any insurance required

hereunder is not provided to the County.

3. All certificates of insurance shall clearly indicate that the Contractor has obtained

insurance of the type, amount, and classification required by this Article. No Work

or Services by Contractor or its Subcontractors shall be commenced until County has

approved these policies or certificates of insurance. Further, the Contractor agrees

that the County shall make no payments pursuant to the terms of this Contract until

all required proof or evidence of insurance has been provided to the County. This

Contract may be terminated by the County, without penalty or expense, if proof of

any insurance required hereunder is not provided to the County.

4. The Contractor shall file replacement certificates with the County at the time of

expiration or termination of the required insurance occurring during the term of this

Contract. In the event such insurance lapses, the County expressly reserves the right

to renew the insurance policies at the Contractor’s expense or terminate this Contract,

but County has no obligation to renew any policies.

D. The provisions of this Article shall survive the cancellation or termination of this Contract.

LIMITATION OF LIABILITY AND INDEMNIFICATION OF COUNTY

A. The Contractor shall indemnify, defend, and hold harmless the County, and its agents,

officers, and employees, from and against all claims, damages, losses, and expenses,

including, but not limited to attorney’s fees, arising out of or resulting from the performance

of this Contract provided that the claim, damage, loss and expense is caused in whole or in

part by any negligent act or omission of the Contractor, the County, any contractor, anyone

directly or indirectly employed by any of them or anyone for whose acts any of them may be

liable hereunder, except the Contractor will not be required to indemnify and hold the County

harmless if such claim, damage, loss and expense is the result of the sole negligence of the

County, or of anyone directly or indirectly employed by the County or anyone for whose acts

the County may be liable.

B. In all claims against the County, or any of its public officials (elected and appointed),

successors and successors in interest, officers, agents, attorneys, and employees by any

employee of Contractor, anyone directly or indirectly employed by any of them or anyone for

whose acts any of them may be liable, no indemnification obligation shall be limited in any

way by any limitation on the amount or type of damages, compensation or benefits payable

by or for Contractor, or any Subcontractor or Sub-subcontractor under Florida’s Workers'

Compensation acts, disability benefit acts, or other employee benefit acts.

C. Contractor’s indemnification obligations under this Section, Limitation of Liability and

Indemnification of County, are subject to County or the indemnified party giving Contractor

(a) prompt written notice of any indemnifiable claim; (b) reasonable assistance in

Contractor’s defense of the indemnifiable claim; and (c) sole authority to defend or settle the

indemnifiable claim, provided that County or the indemnified party shall have the right to

approve any settlement of an indemnifiable claim to the extent such settlement imposes any


obligations on County or the indemnified party. County, or the indemnified party, may retain

its own legal counsel at its own expense to monitor such litigation.

D. Infringement Claim.

1. For all Licensed Software or derivate works of the Licensed Software used by County

under the resulting Agreement, Contractor agrees to protect, defend, indemnify, and

hold harmless County, its agents, elected officials and employees of County from and

against any and all claims, demands, actions, and causes or action which may arise

asserting that all or any part of Contractor’s Licensed Software or applications that

are owned and licensed by Contractor to County for use thereof by County, infringes

or misappropriates any third party’s valid state patent, copyright, trademark, or any

trade secret protected under United States law.

2. In the event of an infringement claim, Contractor shall have the option: (i) to procure

for County the right to continue using any product or service found to be infringing;

(ii) to replace any such infringing product or service with a non-infringing product or

service; or (iii) to modify such infringing product or service to make it non-

infringing. Contractor shall have no obligation under this Section, Limitation of

Liability and Indemnification of County, if the Infringement Claim is based upon the

use of the System in combination with other hardware or software applications not

furnished by Contractor, or if such a claim arises from County’s modification of the

System without the authorization of Contractor.

E. Sovereign Immunity. County expressly retains all rights, benefits and immunities of

sovereign immunity in accordance with Section 768.28, Florida Statutes (as amended).

Notwithstanding anything set forth in any Article of this Agreement to the contrary, nothing

in this Agreement shall be deemed as a waiver of immunity of limits of liability of County

beyond any statutory limited waiver of immunity of limits of liability which may have been

adopted by the Florida Legislature or may be adopted by the Florida Legislature and the cap

on the amount and liability of County for damages regardless of the number or nature of

claims in tort, equity or contract shall not exceed the dollar amount set by the legislature for

tort. Nothing in this Agreement shall inure to the benefit on any third party for the purpose of

allowing any claim against County which would otherwise be barred under the Doctrine of

Sovereign Immunity or operation of law.

F. If either party should become entitled to claim damages against the other party for breach of

contract arising from the Agreement, the party in breach shall be liable only for the amount

of actual direct damages up to a maximum amount equal to the sums paid or payable under

the Agreement.

G. In no event shall either party be liable to the other for any incidental, indirect, special,

punitive or consequential damages even if the party knew or should have known about the

possibility of such damages for any provision of the Agreement.

EXPENSES INCURRED: This invitation does not commit the County to award a contract, nor

shall the County be responsible for any cost or expense incurred by any respondent in preparing and

submitting a reply, nor for any cost or expense incurred by any respondent prior to the execution of a


contract. The County reserves the right to require any or all respondents to appear for interviews

and/or oral presentations at no cost to the County.

AMERICANS WITH DISABILITIES ACT: In accordance with the Americans with Disabilities

Act and Section 286.26, Florida Statutes, persons with disabilities needing special accommodations

to participate in the proceedings should contact the Volusia County Purchasing and Contracts Office



WAIVER: The County of Volusia reserves the right to reject any or all proposals, to waive

informalities and to accept all or any part of any proposal as may be deemed to be in the best interest

of the County.

TERMINATION:

A. The resulting Contract may be terminated by (a) either party upon the material breach by the

other party if such breach is not cured within thirty (30) days written notice from the non-

breaching party, or (b) by County upon at least thirty (30) calendar days, prior written notice

to Contractor whenever the County shall determine that such termination is in the best

interest of the County.

B. County may terminate the resulting Contract for convenience or non-appropriation upon at

least thirty (30) calendar days’ prior written notice to Contractor.

C. The Contractor may cancel the resulting contract with one-hundred eighty (180) days written

notice to the Director of Purchasing and Contracts. Failure to provide proper notice to the

County may result in the Respondent being barred from future business with the County.

D. After Contractor’s receipt of a notice of termination pursuant to Paragraph A above (or to the

extent Contractor has not cured a material breach within thirty (30) days notice from

County), and except as otherwise directed by the County, the Contractor shall:

1. Stop work under the Contract or applicable statement of work on the date specified in

the notice of termination.

2. Place no further orders or subcontracts for materials, services or facilities.

3. Terminate all orders and subcontracts to the extent that they relate to the performance

of work or Services terminated by the Notice of Termination.

4. With the approval of the County and to the extent required by the County, settle all

outstanding liabilities and all claims arising out of such termination of orders and

subcontracts. County's approval of such settlements shall be final for all the purposes

of Section, Termination.

E. After receipt of a notice of termination, the Contractor shall submit to the County its

termination claim for amounts owed by County (which shall include, without limitation, all

amounts due for work or Services performed through the date of termination), in the form


and with a certification as prescribed by the County. Such claim shall be submitted promptly

but in no event later than thirty (30) days from the effective date of termination, unless one or

more extensions in writing are granted by the County, upon request of the Contractor made in

writing within such thirty (30) days period or authorized extension thereof. Upon failure of

the Contractor to submit its termination claim within the time allowed, the County may

determine on the basis of information available to it, the amount, if any, due to the Contractor

by reason of the termination and shall thereupon pay to the Contractor the amount so

determined. In the event County terminates for convenience or non-appropriation,

Contractor shall not be obligated to refund to County any prepaid fees.

F. Non-Appropriation. The resulting Contract may be terminated by the County or Contractor

if the County does not appropriate the funding in any fiscal year necessary to pay the

compensation set forth in the Article entitled Compensation in the resulting contract.

G. In the event that the resulting Contract is terminated by the County or Contractor for non-

appropriation, Contractor shall be paid in accordance with terms of the Article entitled

Compensation in the resulting Contract. Contractor shall be paid (a) to the date of

termination on a prorated basis for any task and Deliverable designated for payment on the

Payment Milestone Schedule that was started but not completed and/or (b) for any work or

Deliverable that has been completed but not yet been paid. County’s obligation to pay

Contractor under this Section, Termination, and the resulting Contract is limited to the

budgeted amount for the fiscal year approved by the Volusia County Council for the then

current fiscal year of the resulting Contract. Contractor shall have no right to compel the

Volusia County Council to appropriate funds for any fiscal year to pay the compensation.

H. Upon being notified of County’s election to terminate for default of Contractor, non-

appropriation or convenience, Contractor and its Subcontractors shall refrain from

performing further work or incurring additional expenses under the terms of the resulting

Contract which is not specifically authorized in the Notice of Termination.

I. If termination of the resulting Contract occurs for any reason:

1. Except as otherwise provided in the resulting Contract, Contractor shall return to the

County, or destroy, all County confidential information in Contractor’ possession and

shall certify the destruction or return of said information in a written document

signed by the duly authorized representative of the Contractor that all such

information has been destroyed or returned, provided that Contractor shall be

permitted to retain an archival copy of any such confidential information (provided it

continues to maintain the confidentiality of such as prescribed herein) to the extent

necessary to have a record of the Service performed hereunder.

2. For all undisputed outstanding invoices submitted to the County for Work completed

or Deliverables delivered prior to the effective date of the termination, the County

shall cause payments to be made to Contractor within forty-five (45) days of receipt

of invoice. Contractor shall invoice the County for any sums Contractor claims to be

owed by County under the resulting Contract for work performed from the last

invoice to the effective date of termination. County shall review such invoice for

payment within fifteen (15) days of receipt and County shall pay any undisputed


amount within forty-five (45), subject to the Article entitled Compensation in the

resulting contract. Any disputed amounts on any invoices shall be subject to the

dispute resolution process set forth in the Article entitled Dispute Resolution in the

resulting contract.

J. In the event of termination by the County for non-appropriation, for all items or products

ordered by Contractor before receipt by Contractor of the Notice of Termination which

Contractor could not cancel without imposition of a fee, the County shall cause payments to

be made to Contractor within forty-five (45) days of receipt of an undisputed invoice for all

cancellation, restocking or residual fees resulting from the cancellation or return of Third

Party Products ordered from or shipped by the vendor thereof prior to the effective date of

the termination.

K. In the event Contractor is unable to deliver the System in a manner that enables the System

and all of its functional components to pass Final Acceptance testing, County shall have the

right to terminate the Contract and have the right to receive from Contractor a refund of any

implementation fees paid through the date of such termination.

CONFLICT OF INTEREST FORMS: All respondents shall complete and have notarized the

attached disclosure form of any potential conflict of interest that the respondent may have due to

ownership, other clients, contracts, or interest associated with this project.

DELIVERY OF PROPOSALS: Firms interested in providing the required professional services

shall submit NINE (9) complete sets of the proposals:

• One (1) hard copy marked “ORIGINAL”

• Seven (7) hard copies marked “COPY”

• One (1) COMPLETE electronic copy on a CD in PDF format (Excel spreadsheets shall

not be recorded in PDF).

Note the solicitation number and name of company on the disk.

Do not send confidential information, proprietary information, or trade secrets.

Failure to provide the required copies and information may result in the proposal not being

considered. Submittals shall be clear, concise, indexed by subject, typed on letter size paper, and

individually bound. Submittals shall be mailed or delivered in a sealed package clearly marked on

the outside with the project name, invitation number, and due date. Packages shall be received in the

Volusia County Purchasing Office by the advertised deadline.

DO NOT RESPOND TO THIS SOLICITATION ON LINE

QUESTIONS/EXCEPTIONS RE: RSQ #12-SQ-110BB

A. It is incumbent upon each respondent to carefully examine this solicitation’s specifications,

scope of work/service, terms, and conditions. Questions and exceptions concerning any

section of this RSQ shall be directed by letter, facsimile transmission or by e-mail to the

Procurement Analyst named below, who shall be the official point of contact for this RSQ.


Questions and exceptions shall be submitted no later than fourteen (14) days before the

closing date. Thereafter, no further questions or exceptions will be accepted or reviewed by

the County and respondents’ right to submit questions or exceptions will terminate and any

questions or exceptions not previously made shall be deemed waived. The issuance of a

written addendum is the only official method by which interpretation, clarification, or

additional information can be given and oral representations will not be binding on the

County.

B. Mark cover page or envelope(s) “Questions/Exceptions re: RSQ #12-SQ-110BB,

Transcription Services”

Submit questions to:

Becki Bishop, Procurement Analyst II

Telephone: ..................386-822-5764

Fax: ............................386-736-5972

E-mail:[email protected]

C. If it becomes necessary for the County to revise any part of this RSQ, an addendum will be

posted on the County’s web site. It is each respondent’s responsibility to check the Volusia

County web site at http://vcservices.vcgov.org/bidlistnet1 for any addenda. Each respondent

should ensure that they have received all addenda to this RSQ before submitting their

proposal. In their proposals, respondents must provide proof of receipt of each addendum by

signing each addendum and returning each addendum to the County. Failure to provide this

proof may cause Respondent’s proposal to be rendered non-responsive.

Each addendum issued by the County shall become a material part of this solicitation. The

resulting contract shall be the final decision on the subject of the addendum.

PROPOSAL ACCEPTANCE PERIOD

Any proposal in response to this RSQ shall be valid through for nine (9) months from the closing

date. At the end of this time the proposal may be withdrawn at the written request of the respondent

if no award has been made. If the proposal is not withdrawn at that time it remains in effect until an

award is made or the RSQ is canceled regardless of the status of the Proposal Bond. The County

reserves the right to request an extension of the proposals if the contract has not been negotiated

within nine (9) months from the closing date.

ASSIGNMENT

Contractor may not assign or otherwise convey Contractor’s rights and/or obligations under this

Agreement without first providing County with a processing fee of Five Hundred Dollars (US

$500.00) and obtaining County’s prior written consent, which consent County may withhold, limit

and/or condition in County’s sole discretion, including, but not limited to posting a performance

bond. Any consent by the County under this section shall be by written amendment to the

Agreement in a form and substance specified by the County in its sole discretion. If Contractor

desires to assign or otherwise convey its rights and/or obligations under this Agreement, Contractor

shall, no less than one hundred twenty (120) days prior to the assignment’s proposed effective date,

provide County with a written request for County’s consent.


http://vcservices.vcgov.org/bidlistnet1


Failure by the Contractor to obtain the County’s consent in accordance with this section prior to

assignment or other conveyance shall: 1) constitute a material breach of the Agreement; and 2)

entitle the County to retain any and all legal rights, claims and defense to enforce this section,

including, but not limited to, injunctive, declaratory, damages and attorney’s fees and costs.

Payment of any sum by the County in accordance with the Agreement to the Contractor or any

person or entity prior to the Contractor obtaining the County’s consent to the assignment shall not

constitute a waiver of the rights of the County under this section.

Nothing herein shall preclude the right of the County to waive its rights under this section but no

waiver shall be granted by the County without amendment to the Agreement. The Contractor is

hereby placed on notice that the County may demand a discount of up 10% (ten percent) from those

rates or compensation for the goods or services established in the Agreement as a condition to

execution of the amendment.

USE OF COUNTY LOGO

County owns and retains all proprietary rights in its logos, trademarks, trade names, and copyrighted

images (“Intellectual Property”). As such, nothing in this solicitation permits or shall be construed

as authorizing Respondent to use or display County’s Intellectual Property on Respondent’s

submittal documents or proposal (including any exhibits attached thereto) submitted to County by or

on behalf of Respondent in response to this solicitation. Unless expressly authorized in writing by

County, Respondent is not authorized and shall not make use of or display any County Intellectual

Property on or in its proposal or submittals in response to this solicitation. Unauthorized use of

County’s Intellectual Property may constitute trademark and/or copyright infringement in violation

of federal and state laws and may result in your submittal being deemed non-responsive.

DISCLOSURE OF PROPOSAL CONTENT

A. All material submitted becomes the property of the County and may be returned only at the

County's option. The County has the right to use any or all ideas presented in any reply to

this RSQ. Selection or rejection of any Proposal Submittal does not affect this right.

B. The County of Volusia, Florida, is governed by the Public Record Law, Chapter 119, Florida

Statutes (F.S.).

SUBMITTAL REQUIREMENTS

Proposals shall include all of the information solicited in this RSQ, and any additional data that the

respondent deems pertinent to the understanding and evaluating of the proposal. Proposals shall be

organized and sections tabbed in the following order. The respondent should not withhold any

information from the written response in anticipation of presenting the information orally or in a

demonstration, since oral presentations or demonstrations may not be solicited. All proposals shall

include at minimum:


Tab 1. Qualification Data

A. Submittal Letter signed by authorized agent of the firm with documentation, such as a

Memorandum of Authority, that this individual is authorized to commit the firm to a

contract. Clearly state the name, title and contact information for the individual designated

by the firm as contact point for any requests for additional information required by County.

B. A brief profile of the firm, including:

1. A brief history of the business

2. Organizational structure of business

3. Ownership interests

4. Active business venues (counties, states, etc.)

5. The overall qualifications of the business to provide the services requested

6. Documentation from the appropriate state’s agency confirming firm’s legal entity

type (e.g., Sole Proprietorship, Partnership, Limited Liability Partnership,

Corporation, Limited Liability Corporation, etc.). For non-Florida businesses submit

documentation from the state in which the business was formed and documentation

from the State of Florida providing authorization to perform business in the state of

Florida. Provide a Florida Department of State, Division of Corporations’ Sunbiz

report available at www.sunbiz.org; and

Tab 2. References

Provide three (3) references of the same or similar magnitude to this solicitation request within the

last five (5) years, including company name, contract person, phone number and e-mail address.

Provide a short description of each project, to include the name of the project, location, type and

value. Unless specifically asked by the County, the County of Volusia shall not be listed as a

reference.

Tab 3. Project Methodology and Approach

Submittal shall include a detailed narrative of the approach to the project along an estimated timeline

and implementation plan. Implementation plan shall not be generic, but customized to this RSQ.

Explain how the firm intends on sending the information from the point of origin to the County’s

website, volusia.org and to LCD/TV monitors in the County Council chambers. Include information

on the firm’s ability to identify the current person speaking and how this is accomplished through

your services.

Tab 4. Cost Proposal

Submittal shall include a breakdown of hourly rates for transcription services and any/all equipment

necessary to utilize the Contractor’s services. Include after-hours rates and at what hour said rates

http://www.sunbiz.org/


begin, if after 5:00 p.m. EST, as well as cost for electronic and hard-copy transcripts. Include

detailed descriptions on all equipment and/or software that will be utilized for the resulting Contract.

Tab 5. Resources and Qualifications of the Respondent’s Personnel (4 pages max.)

The Respondent shall provide a brief description of what additional resources the Respondent

possesses to complete these services and the qualifications of the firm’s employees who will work on

this contract, including resumes demonstrating the experience of the personnel that will be directly

involved with this project. Provide information on the proposed Project Manager’s qualifications

and experience that shall be assigned to this project. The Respondent shall provide an organizational

chart showing the reporting structure and where the proposed project would be assigned within the

organization.

Tab 6. Insurance

Attach evidence of required insurance coverage or proof of insurability in the amounts indicated. If

available, a properly completed ACORD Form is preferable. Final forms must contain the correct

solicitation and/or project number and name of Volusia County’s contact person.

Firms that have owner/operators that have filed a "Notice of Election to be Exempt" shall submit a

copy with the proposal. Respondent shall certify number of employees if sole proprietor.

Incorporated and unincorporated firms that qualify for an exemption under the Florida Worker’s

Compensation law in Chapter 440 Florida Statutes shall submit an executed waiver relieving the

County of liability in the event they are injured while providing goods and/or services to the County.

Tab 7. Conflict of Interest Disclosure Form (use attached forms)

All Respondents shall properly complete, have notarized and attach with their proposal the attached

notarized disclosure statement of any potential conflict of interest that the Respondent may have due

to ownership, other clients, contracts or interests associated with this project.

Tab 8. Business Tax Receipt (BTR)

To be responsive to this solicitation, each Respondent who is currently required to have a Business

Tax Receipt (BTR) at the time of submittal shall provide a copy of their current BTR in their

response to this solicitation.

There are two exceptions to this bid submission requirement:

A. If Respondent’s business does not have a physical location in Volusia County, no submission

is required, or

B. If Respondent’s business type is exempted, submit a Proof of Exemption approved by the

Volusia County Revenue Director (see attached Proof of Exemption Form).

See Volusia County Code of Ordinances, Part II, Code of Ordinances, Ch. 114, Taxation, Article I, at

http://www.municode.com/resources/gateway.asp?pid=11665&sid=9.

http://www.municode.com/resources/gateway.asp?pid=11665&sid=9


Tab 9. Addenda

Any addenda issued subsequent to the release of this solicitation must be signed and returned with

the firm’s proposal. Failure to return signed addenda may be cause for the proposal to be

considered non-responsive.

Tab 10. Completed Taxpayer Identification Number (TIN) form.

Include a completed TIN form. If the firm is not registered with Volusia County, on-line registration

is available at www.volusia.org/purchasing under Vendor Self Service, which links to the registration

site. The TIN form can be accessed through this site as well.

Tab 11. Financial Stability

All respondents shall be prepared to supply a financial statement upon request, preferably a certified

audit, but a third party prepared financial statement and the latest D & B report may be accepted.

http://www.volusia.org/purchasing


PROPOSAL FORM

________________________, 2012

TO: County of Volusia, Florida

Office of Purchasing and Contracts Director

123 W. Indiana Avenue, Room 302

DeLand, FL 32720-4608

The undersigned hereby declares that [firm name] ______________________________________

has carefully examined the specifications to furnish Transcription Services for which proposals

were advertised to be received no later than 3:00 p.m., local time, on Tuesday, September 25,

2012, and further declare that the firm will furnish the services according to specifications contained

herein.

Sole Proprietor YES NO Total number of employees _______

Please respond to the following pertaining to the cost of services:

Each vendor shall provide hourly rates for personnel to be used to supply the transcription services.

Rates shall include straight time (9:00 a.m. through 5:00 p.m. EST) and overtime (after 5:00 p.m.

EST).

Any /all costs associated with one-time installation, implementation, equipment, software, and/or any

other elements involving cost shall be included within this section. Each element shall be detailed

individually. (Submit in Tab 4)

Prompt Payment Discount, if applicable: __________ % __________ Days; Net 45 Days

Do you accept electronic funds transfer (EFT)? YES NO

Do you offer a discount for electronic funds transfer (EFT)? YES NO

Have you supplied all the Submittal Requirements outlined below?

Qualification letter and data

References

Project Methodology and Approach

Cost Proposal

Resources

Insurance

Conflict of Interest

Business Tax Receipt

Addenda

Completed Taxpayer Identification Number (TIN) form

Financial Statement, upon request

The vendor acknowledges that information provided in this proposal is true and correct:

The County of Volusia reserves the right to reject any or all proposals, to waive informalities, and to


accept all or any part of any proposal as they may deem to be in the best interest of the County.

I hereby certify that I have read and understand the requirements of this Request for Statements of

Qualifications No. 12-SQ-110BB, Transcription Services, and that I, as the Respondent, will

comply with all requirements, and that I am duly authorized to execute this proposal/offer document

and any contract(s) and/or other transactions required by award of this RSQ.

Further, as attested to by below signature, I will provide the required insurance, per Insurance

Requirements section above, upon notification of recommendation of award.

Company: ____________________________________________________________________

Per: _________________________________________________________________(Print name)

Signature: ____________________________________________________________________

Address: _____________________________________________________________________

City: ___________________________________ State: ________ ZIP: _________________

Telephone: _______________________________ Fax: _______________________________

E-Mail Address:________________________________________________________________

DUNS#: _______________________ Fed. I.D. #: ___________________________________


CONFLICT OF INTEREST FORM

I HEREBY CERTIFY that

1. I, (printed name) ________________________________________________________, am the

(title) _______________________________________ and the duly authorized representative

of the firm of (Firm Name) _________________________________________ whose address is

____________________________________________________, and that I possess the legal

authority to make this affidavit on behalf of myself and the firm for which I am acting; and,

2. Except as listed below, no employee, officer, or agent of the firm have any conflicts of

interest, real or apparent, due to ownership, other clients, contracts, or interests associated

with this project; and,

3. This Bid Submittal is made without prior understanding, agreement, or connection with any

corporation, firm, or person submitting a proposal for the same services, and is in all respects

fair and without collusion or fraud.

EXCEPTIONS to items above (List):___________________________________________________

_________________________________________________________________________________

Signature: _____________________________________________ Date: ______________

Printed Name:_________________________________________________________________

Firm Name: _________________________________________________________________

STATE OF _____________________________

COUNTY OF ___________________________

Sworn to and subscribed before me this ______ day of ____________________, 20______, by

_____________________________________________________, who is/are personally known to me or who

has/have produced ____________________________________ as identification.

______________________________________________

NOTARY PUBLIC – STATE OF ___________________

Type or print name:

______________________________________________

Commission No.:________________________________

(Seal) Commission Expires:_____________________________


Notification Regarding Public Entity Crime and Discriminatory

Vendor List Requirements and Disqualification Provision

A. Pursuant to Florida Statutory requirements, potential Respondents are notified:

287.133(2)(a) A person or affiliate who has been placed on the convicted vendor list following a

conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any

goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public

entity for the construction or repair of a public building or public work; may not submit bids, proposals,

or replies on leases of real property to a public entity; may not be awarded or perform work as a

contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not

transact business with any public entity in excess of the threshold amount provided in s. 287.017 for

CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor

list.

287.133(2)(b) A public entity may not accept any bid, proposal, or reply from, award any

contract to, or transact any business in excess of the threshold amount provided in s. 287.017 for

CATEGORY TWO with any person or affiliate on the convicted vendor list for a period of 36 months

following the date that person or affiliate was placed on the convicted vendor list unless that person or

affiliate has been removed from the list pursuant to paragraph (3)(f). A public entity that was transacting

business with a person at the time of the commission of a public entity crime resulting in that person

being placed on the convicted vendor list may not accept any bid, proposal, or reply from, award any

contract to, or transact any business with any other person who is under the same, or substantially the

same, control as the person whose name appears on the convicted vendor list so long as that person's

name appears on the convicted vendor list.

287.134(2)(a) An entity or affiliate who has been placed on the discriminatory vendor list may

not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may

not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a

public building or public work; may not submit bids, proposals, or replies on leases of real property to a

public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant

under a contract with any public entity; and may not transact business with any public entity.

287.134(2)(b) A public entity may not accept any bid, proposals, or replies from, award any

contract to, or transact any business with any entity or affiliate on the discriminatory vendor list for a

period of 36 months following the date that entity or affiliate was placed on the discriminatory vendor list

unless that entity or affiliate has been removed from the list pursuant to paragraph (3)(f). A public entity

that was transacting business with an entity at the time of the discrimination resulting in that entity being

placed on the discriminatory vendor list may not accept any bid, proposal, or reply from, award any

contract to, or transact any business with any other entity who is under the same, or substantially the

same, control as the entity whose name appears on the discriminatory vendor list so long as that entity's

name appears on the discriminatory vendor list.

B. By submitting a proposal, the Respondent represents and warrants that the submission of its

proposal does not violate Section 287.133, Florida Statutes (2005), nor Section 287.134, Florida Statutes

(2005).

C. In addition to the foregoing, the Respondent represents and warrants that Respondent,

Respondent’s subcontractors and Respondent’s implementer, if any, is not under investigation for

violation of such statutes.

D. Respondent should read carefully all provisions of 287.133 and 287.134, Florida Statutes (2005).


PROOF OF EXEMPTION

FINANCIAL AND ADMINISTRATIVE SERVICES REVENUE DIVISION

123 W. INDIANA AVE. ROOM 103 DELAND, FL 32720-4602

PHONE: 386-736-5938 FAX: 386-822-572

http://volusia.org/revenue/

I certify that the business known as (business name) ___________________________________________________,

providing ___________________________ services, which is located at (street address) _______________________

____________________, (city) _________________________, falls under the business tax exemption described in:

Florida Statute 205. 063 Florida Statute 205. 065 Florida Statute 205. 191

Florida Statute 205. 064 Florida Statute 205. 162 Florida Statute 205. 192

Florida Statute 205. 171

www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0205/ch0205.htm

OR is the type of business indicated below:

Child Care – Residential Insurance Adjuster, Radio/Television Station

Commercial Rentals Agent, or Company Religious Institution

Door to Door/Peddler Sales Pharmacist/Pharmacy Residential Rentals over 6months

(Prescription Drugs Only) Sale of Alcoholic Products only

_____________________________________ _____________________________________ (Authorized Signature) (Printed Name)

STATE OF _____________________________

COUNTY OF ___________________________

Sworn to and subscribed before me this ______ day of __________________, 20______, by

_____________________________________________________, who is/are personally known to me or who

has/have produced ____________________________________ as identification.

_______________________________________

NOTARY PUBLIC – STATE OF _____________

Type or print name:

_______________________________________

Commission No.: _________________________

(Seal) Commission Expires: ______________________

A business that falls under one of the exempt classifications listed above is not required to have a Volusia County

Business Tax Receipt.

_____________________________________

Margaret Flomerfelt, Revenue Director

http://volusia.org/revenue/default.htm

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0205/ch0205.htm


HOLD HARMLESS AGREEMENT

I, __________________________________________, (print owner’s name), am the owner of

____________________________________________________ (print company name), an incorporated

/ unincorporated business operating in the State of Florida. As such, I am bound by all laws of the

state of Florida, including but not limited to those regarding the workers’ compensation law.

I hereby affirm that I or [the above-named business] employs fewer than four employees, all

of whom are listed below, including myself, and therefore, the business is exempt from the statutory

requirement for workers’ compensation insurance for its employees. I certify that I will provide the

County of Volusia with the name of each new employee together with all required waivers and

releases for each prior to any employee being allowed to work to provide services under the contract

set forth below. If any such employee is allowed to work without a signed waiver and release, such

action will be a material breach of this Agreement. All signed waivers and releases shall be

furnished before the commencement of any work by an employee or the undersigned to the County

Project Manager or designated County representative.

On ________________, 20___, the County of Volusia and I or [the above-named business]

entered into a contract for __________________________________ (please insert name of

contract), (hereinafter “Agreement”) which is incorporated by reference herein.

On behalf of myself, my business, and the employees listed below, I and they hereby agree to

waive and release any and all workers’ compensation claims or liens under Chapter 440, Florida

Statutes, against the County of Volusia and its agents, officials and employees, arising from any

work or services provided under the Agreement whether or not it shall be alleged or determined that

the act was caused by intention, or through negligence or omission of the County of Volusia or its

agents, officials and employees or subcontractors.

In the event that a workers’ compensation claim or lien is made against the County of Volusia

and/or its agents, officials or employees by myself or my employees or agents as a result of any work

or services performed under the Agreement, I agree to indemnify, keep and hold harmless the County

of Volusia, Florida, its agents, officials and employees, against all injuries, deaths, losses, damages,

claims, liabilities, judgments, costs and expenses, direct, indirect or consequential (including, but not

limited to, fees and charges of attorneys and other professionals) arising out of the Agreement with

the County of Volusia, whether or not it shall be alleged or determined that the act was caused by

intention or through negligence or omission of the County of Volusia or its employees, agents, or

subcontractors. I or the above-named business shall pay all charges of attorneys and all costs and

other expenses incurred in connection with the indemnity provided herein, and if any judgment shall

be rendered against the County of Volusia in any action indemnified hereby, I or the above-named

business shall, at my or its own expense, satisfy and discharge the same. The foregoing is not

intended nor should it be construed as, a waiver of sovereign immunity of the COUNTY OF

VOLUSIA under Section 768.28, Florida Statutes.


Owner: ___________________________ (print name) ___________________________ (signature)

Employee 1: ___________________________ (print name) ___________________________ (signature)



STATE OF _____________________________

COUNTY OF ___________________________

Sworn to and subscribed before me this ____ day of ________________, 20____, by

_____________________________________________________, who is/are personally known to

me or who has/have produced ____________________________________ as identification.

__________________________________________

NOTARY PUBLIC – STATE OF ________________

Type or print name:

__________________________________________

Commission No.: ___________________________

(Seal) Commission Expires: ________________________


REFERENCES

Agency #1

Address

City, State, ZIP

Contact Person

E-mail

Phone:

Date(s) of Service

Type of Service

Comments:

Agency #2

Address

City, State, ZIP

Contact Person

E-mail

Phone:

Date(s) of Service

Type of Service

Comments:

Agency #3

Address

City, State, ZIP

Contact Person

E-mail

Phone:

Date(s) of Service

Type of Service

Comments:

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